Neurology Recap

I've certainly been bad at updating this past month. I don't know why, really, because I think about it a lot, I just couldn't find time to get on the computer and pour my brain onto my keyboard. Anyway, lots of things going on: the weather is finally turning beautiful (and tulips everywhere made my heart sing), I'm getting somewhere (finally!) in wedding planning!, and I've learned a tiny little bit about neurology. I need to learn more, but thankfully we don't have the exam until next month after psych is over.

Trying to recap neuro is sort of a difficult task. Let me start out by saying that I think neurological disorders are super interesting, but I am never going to be a neurologist. Ever.

So I started out my neuro month in the clinic. That was okay, I saw lots of different things but it was basically just a glorified shadowing experience. Actually not even that glorified. My first day, Carol (the awesome nurse) told me that I was going to work with Dr. B (the "very busy" chairman of the neurology dept - he always wears bow ties, and must be from NY or something by the way he talks). Anyway, Carol explained to me that Dr. Berger is a very busy and important man and did not wait for anybody. Therefore, I needed to only knock on his door when a patient was ready, stick my head into his office and hold up one finger (indicating one patient ready). Then, I was instructed to wait by the patient's room until he was ready to see them. I did all this, and soon Dr. Berger flew out of his office into the patient's room. He said to me "Are you the medical student? What's your name?" and shook my hand (and about broke it in half) as I told him my name. We got into the room about 0.3 seconds later and he said "Katie, sit right there and be quiet." And I did.

And that was my first morning with neurology.

The rest of the clinics were a little less intense than the first experience, but still...not my thing. One good thing about neurology though is that they have tons of conferences with food. I definitely ate well this month!

The following week I moved on to Child neurology. Basically: Kids with Seizures service. It was a good week because we had a good resident (and a pretty good attending too), but pretty sad. The kids with seizures were often drug babies, their moms had had 7 or 8 other kids, took drugs, and didn't keep any of the kids themselves. These poor children had cerebral palsy, epilepsy, and brain malformations. Thankfully, the kids had been adopted by amazing parents and had great opportunities but it still made me angry to think that these children have no ability to reach their full potential because their stupid mother was too irresponsible to either 1) not do drugs while pregnant or 2) use a condom.

Following the kiddos, I moved onto stroke service. They either assign you to general or stroke. Stroke sees, well, strokes, and general sees everything else (read: all the cool stuff). I had a very interesting man as my attending. Dr. Phe was very intelligent and never used contractions when he was speaking and continually told us (the "hardworking and diligent medical students") that we needed to get our tuition's worth. I saw a lot of strokes. That's about it.

Actually, I saw a lot of heartbreak too. My very first patient was a large lady who had a very large stroke - it killed nearly half her brain. I was supposed to go down there and "gather a history" but since she wasn't able to communicate I asked her daughters (she herself was only 60) what had happened. They said they were enjoying Easter dinner and were sitting out on the back porch when she suddenly stood up, walked inside, and laid down on the bed. They went in a few minutes later looking for her and found her unresponsive and unable to move half her body. How scary is that?

We had a different (and very wonderful) attending the first few days of stroke, and we had a "family meeting" with this patient's family to discuss options. There was TWENTY THREE family members present for the meeting. It was insane. We had to find a conference room where they would all fit! Dr. D told them that their mom had had this huge stroke, and she may get better or she may die. It depended on swelling in her brain, and they need to discuss DNR status and so on. It was intense. I was sure she was going to die, but fortunately she's improved (somewhat) and I think she might get to go home this weekend. Not really a happy ending because of her huge disability, though, but happier.

Later the first morning, we were standing in the hall on rounds and A PATIENT CODED! In a room only 5 feet away from us! This was my first "real" code that started when I was present. An alarm went off and a bunch of nurses ran into the room. Then I waited for my doctors to go in before me (because I think technically whoever gets there first runs the code - and it sure as heck wasn't going to be me!). I watched all the commotion from the back corner of the room (trying to stay out of the way when there's 20 people in one room is difficult). She was actually one of the patients we were about to round on. She didn't make it, unfortunately.

The rest of the two weeks was more of the same but not quite as intense. I saw tons of patients who were perfectly normal then severely disabled in a matter of minutes. I got to watch an embolectomy - they go into the brain's blood vessels by threading a catheter from your leg up to your head, then try to grab the clot and pull it out. They only got part of it, but we went to tell the family that the surgery was partially successful, then we found out about 10 minutes later that the woman was deteriorating and she passed away in the middle of the night. Again, depressing.

I saw two patients with a rare and very interesting syndrome called Gerstmann's Syndrome. It happens when you have a stroke in one particular area of your brain that causes you to have the following symptoms:
1. Dysgraphia/agraphia - unable to write
2. Dyscalculia/acalculia - unable to make calculations
3. Finger agnosia - loss of the ability to recognize fingers
4. Left-right disorientation - can't show me her right/left hand, etc.
It's apparently really rare and we had two patients in two days with it. Pretty cool.

Anyway, not my favorite month this year. Actually much less than favorite. But that's good, I like it when I can narrow down my options a little more. :)